Last year J. Bailey collaborated with National Heart, Lung, and Blood Institute (NHLBI) to organize an international workshop on the utilization of ECG databases, the preservation and use of existing ECG databases, and development of future resources . The workshop recommended development of a National ECG Database Archive that investigators could use for research, for algorithm development, and for testing analytical and clinical programs. This database could be put on its own server and it could be accessed via advanced internet technology (ethernet rates at 10 megs/sec). This archive would include ECG databases collected by various NHLBI funded clinical trials and epidemiology studies such as Framingham. Private and academic centers could also participate. Until such resources become available, a preliminary development was considered that would be a "virtual" archive consisting of databases whose developers are willing to share and to register those databases on a website. This registry would allow investigators to find out what's available and who to contact. If enough databases were listed, the registry could evolve to a National Archive as envisioned above. The NHLBI ECG Database Registry has been implemented on a website. To date the Framingham epidemiology study, the Wake Forest Medical Center, and the Syracuse Veterans Administration Medical Center have registered databases. Investigators from Spain, Germany, and Scotland have expressed interest. J. Bailey collaborated with an endocrinologist and U.S. Uniform Health Services (USUHS) and a pediatric cardiologist at Walter Reed Army Medical Center (WRAMC) to design a research protocol using heart rate variability to study autonomic neuropathy in diabetic children. It is believed that this tool can be used to reveal subclinical neuropathy and to correlate the onset and severity of neuropathy with duration of diabetes and degree of glycemic control. In June of this year the intramural research board of WRAMC approved the protocol. J. Bailey and a member for NHLBI assisted the Agency for Health Care Policy and Research to prepare a technical analysis of signal averaged electrocardiograms and their clinical application for the Heath Care Financing Administration, which was presented last fall. Following that analysis, J. Bailey reviewed the literature from 1986 forward and compared signal averaged electrocardiography to other diagnostic modalities (left ventricular ejection fraction, ambulatory electrocardiograms, invasive electrophysiological stimulation) for its potential for predicting pathological arrhythmic events long term after acute myocardial infarction; this was presented at the annual meeting to the International Society for Computerized Electrocardiography. J. Bailey is the chairman for the ECG Committee of the Association for the Advancement of Medical Instrumentation (AAMI); working groups overseen by the committee have finished work on two drafts establishing American National Standards . A collaboration with the cardiology department of Children's National Medical Center is nearly finished; completion of a manuscript awaits analysis of the data by SAS routines. Future Plans: The NHLBI ECG Database Registry will be maintained and databases representing NHLBI clinical trials and epidemiology studies as well as foreign studies will be added. The USUHS/WRAMC study will proceed this fall when they have acquired the necessary table-tilt and ECG equipment. (No additional equipment is needed by MSCL). Current drafts are undergoing review by the AAMI Standards Board; following that review the drafts will be submitted to the American National Standards Institute and following approval will be accepted and published as American National Standards. Working groups under the AAMI ECG Committee will produce additional drafts for American National Standards relating to ECG devices.